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Dentistry Uncensored with Howard Farran

Dentistry Uncensored with Howard Farran

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How to perform dentistry faster, easier, higher in quality and lower in cost.

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Top Practice Mistakes with Sandy Pardue : Howard Speaks Podcast #32
Top Practice Mistakes with Sandy Pardue : Howard Speaks Podcast #32
12/18/2014 12:00:00 AM   |   Comments: 6   |   Views: 2516
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Sandy Pardue and Howard Farran talk about staff problems, lack of systems, staff training, broken appointments, patient retention, and more! There’s a reason Sandy is considered the gold standard in practice management.


Listen to the Show on iTunes
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Listen to the Audio Here:

Audio Howard Speaks Podcast #32 with Sandy Pardue

Watch the Video Podcast Here:

Video Howard Speaks Podcast 032 Sandy Pardue

Links and References from the Show:
Open Dental Practice Management Software
Lighthouse 360 Patient Reminder System

Sandy Pardue's Bio:
Sandy Pardue is a lecturer, author and practice management consultant. She has assisted hundreds of doctors with practice expansion and staff development over 25 years. She is known for her comprehensive and interesting approach to dental office systems, and offers a refreshing point of view on how to become more efficient and productive in a dental practice. Sandy is Director of Consulting with Classic Practice Resources in Baton Rouge, La. She can be reached at sandy@classicpractice.com or 800-928-9289.


Transcript
(Download here)

Howard Farran: It is a great privilege to me to be interviewing a mentor of mine, an idol of mine. You are a legend on Dentaltown. We started Dentaltown back in ’99. You were on it right out of the gate. I think you have more posts than I do. You have like, 23,000 posts and I have 18,000 posts. You share so much. I mean, it started all the way back in the day. Anybody could ask you a question and you would stop what you were doing in your extremely busy dental office and you would answer it. And here it is, what, 20 years later, ’99 to 2014. So what is that? Fifteen years later. Now you are a household name. You actually lecture now more than I do. I mean, you are just incredible, Sandy. And what I love about you is what I don’t like about consultants is a lot of them are from big cities like New York or L.A. or Key Biscayne, Florida and they always want this high-end stuff. And you are from little, old, bitty Baton Rouge, Louisiana and I am from Kansas and it just seems like the greatest companies in America came from the rural areas, not the big urban areas. Because in the big urban areas, you could find that little small piece of pie that would cater to your craziness, but when you are in a small town of 5,000, 10,000, 20,000, you have got to get real and you have got to keep it real. And you are the most real practice management consultant that I have ever known. I have had the honor to have you come in my office. And I want to start with this, Sandy. I know you could lecture, your lecture on Dentaltown on embezzlement is huge. I can’t believe, probably about half of the dental offices are getting embezzled from. In fact, I would love to get you back to do a podcast just on that. Can we come back on that sometime?

Sandy Pardue: Absolutely, absolutely.

Howard Farran: But where I want to start is this, Sandy. You and I have been in this game for 25, 30 years. We just had 5,000 dental school graduates graduate with $300,000 in student loans. A lot of dentists have been out for six or seven years since that huge recession back in 2008, which of all the recessions I have lived through in 52 years, that was the double whammy. I mean, that wasn’t a punch in the gut, that wasn’t a kick in the crotch, that was a knock out. And I think a couple of years later we were just barely getting back to our feet. So there are a lot of dentists out there, Sandy, who in the last five or six years say, “Sandy, my office isn’t going anywhere. It is not going down, it is not going up. It is just flat. It is malaise.” These kids coming out of school, “Should I just get a job? Should I start my own practice?” A lot of people are saying on Dentaltown that the golden years are over and dentistry is ruined. So my advice to you, what would you tell, Sandy, a 25-year-old woman dentist who just graduated in the last five years and is kind of sitting there looking like a deer looking in headlights. What should she do? How should she look? Where is she going to be sitting in 30 years like you and me?

Sandy Pardue: A lot of that is going to depend on her pocketbook. I will tell you, I get a lot of these 25 and 27-year-old dentists that call me and they can afford to start a practice from scratch. So that is the first thing I am going to find out. They might want to work for somebody like Heartland for a few years, get some experience, and then open their own practice. So that is really going to depend on their individual financial situation, but I am going to tell you, I know a lot of young docs, going in and starting these scratch practices and I think it would really get the attention of a lot of seasoned dentists to see how successful they really are.

Howard Farran: And what factors and variables do you think are attributing to their success?

Sandy Pardue: Their mindset. Some of these guys, they are born leaders. And I can name them off. Some are on Dentaltown, some are so busy they don’t get on Dentaltown as much as they would like to, but that is where I met a lot of them. I mean, I can think of a couple by the time they were 32 that had already owned, eight, ten or twelve practices and I met them on Dentaltown when they were in dental school. So there are people out there having a lot of success. It is not necessarily all the bad news.

Howard Farran: Now we, you know, a big error is calling our country the United States of America, when we should really be thinking of it as like Europe. Like nobody compares Germany to Greece or Spain to Portugal or Finland. But in the United States, people kind of stir it all in to one. Are you seeing a lot of variance in success depending on where they go in the country? Urban versus rural, East Coast, West Coast? You are seeing…?

Sandy Pardue: Oh, absolutely. If a young doc, 25-year-old female calls me and says, “Sandy, I want to practice in California. I want to practice in Los Angeles.” Well, I really advise her against that, because it is going to be tough for her. Look at all of the dentists. Although we think of people that you and I both know that practice outside of Los Angeles that have 20 staff doing really well. So a lot of it depends on what they are doing within their own four walls, seriously.

Howard Farran: Yeah, but a lot of those guys that are so successful, like in the recession my office did great, but that is because I had been there 25 years and the word of mouth referral. Most of my word of mouth referrals are the babies coming in that I treated their parents 25 years ago when they were babies. But yeah, look at Downtown San Francisco, 450 Sutter Street with 169 dentists in one building.

Sandy Pardue: Crazy.

Howard Farran: Crazy. And then you go an hour away from San Francisco and there are cities with 1,600 people that don’t even have a dentist.

Sandy Pardue: And I can think of two clients that I have worked with outside of San Francisco that have two million dollar practices.

Howard Farran: Outside of San Francisco or inside?

Sandy Pardue: I would say outside of Napa, yeah in that area.

Howard Farran: Yeah, so demographics are huge. You say these guys were natural born leaders. Can leadership be taught, Sandy? I mean, can you learn leadership or is that kind of an innate, hardwired character that you are born with or without?

Sandy Pardue: These young guys coming out of school, the ones that do real well right off, I think they have that trait. But just if you don’t have it, that doesn’t mean to give up, because a lot of people can learn it.

Howard Farran: And define it. What traits are you seeing in these people that you call natural born leaders?

Sandy Pardue: Oh, they are hungry for CE. They are hungry for it. In fact, there is a thread on Dentaltown.com right now where a guy wants to go to a course. He is in dental school and he wants to go to a course to learn how to set up his practice. And a lot of people are coming on and saying, “No, I wouldn’t do that.” And then others are encouraging him. So these guys, they realize there is more to dentistry than the technical aspect. There is more than a root canal and a crown and they have got to learn how to hire people and set up systems.

Howard Farran: Yeah, I always thought it was crazy in Arizona, they mandate 25 hours of CE a year. I have never done under 500. And I see these people always complaining about having to take three courses and they have to stay until the end of the day, and I am just like… And another thing I see on those courses is half of the room of every lecture is just single dentists and then the other half of the room is 20% dentists and then their five, six, seven staff.

Sandy Pardue: Right.

Howard Farran: And those dentists that bring all of their staff always are making two to three times as much money as all of the dentists coming alone who are “saving money.” And they just don’t get it.

Sandy Pardue: Absolutely.

Howard Farran: And the smartest dentist, the richest dentist, the most successful are the ones that send their whole staff and they don’t even go to the seminar.

Sandy Pardue: Yep.

Howard Farran: They are out playing golf all day and they have got 15 people in there taking the course.

Sandy Pardue: They get it.

Howard Farran: Yeah, they get it, because Ray Crock is dead, but 40,000 McDonald’s are going on. Sam Walton is dead, but they open up 40 new Wal-Marts a month. So that dentist isn’t there today and someday he is going to be dead, but his business is still going to be going.

Sandy Pardue: That is right.

Howard Farran: Yeah. So you were telling me that the top five most common problems that you see on Dentaltown is number one, lack of consistent management – leadership and staff problems – number two, lack of systems organization, number three, staff training just about non-existent, number four, broken appointments, number five patient retention. I want to talk to you about number two. We talked about leadership, but lack of systems organization. My pet peeve, which you know I have had for 25 years, is that dentistry is the only franchise business model in the world where the management information system is not connected up to accounting, like Quicken Online. So these dentists will sign up for a PPO fee and they don’t even know if they make or lose money on these fees. When their existing Dentrix, Eaglesoft, Softdent, it already has a link to time your scheduling for a filling. It already knows how many hours you are opening. The staff should be clocking in and clocking out on that. I mean, payroll is your number one cost. Your supplies, you should be able to set up an account of supplies to what goes towards procedures. And when you came in my office, it was amazing how many things you were teaching me that I would have to track separately on a piece of paper, because this can’t even be done on dental management information software. And the other thing about dental management information software is they tell you. The people that sell Dentrix and Eaglesoft, they tell you that when they go into an office, 85% of the software is never used.

Sandy Pardue: Right.

Howard Farran: And it is like McDonald’s, the only software on the cash register is exactly how to check in and check out a person. So by throwing 40,000 million features on there, it is an overwhelming cluster of confusion, so now you couldn’t even train the staff. I mean, is anyone ever just going to, should I just do it myself, start Quicken Online?

Sandy Pardue: I think that will happen.

Howard Farran: I mean, anybody. Anybody, I mean, an idiot could build a better management information software than anything the dentist can buy on the market. I mean, it just blows my mind.

Sandy Pardue: Right, it is lacking a lot. It definitely is lacking a lot, you are right.

Howard Farran: It is everything wrong, no accounting deals, way too many features, so the receptionist is just like, “What the hell do you do?” So she is so overwhelmed, she misses half of the steps. Those software systems should have an exact way to check in a patient, an exact way. I mean, there should only be one way to do anything and it should cover everything you need. And so if you came into an office today, tell them what you are doing. You are going to have to teach these people to do a lot of systems by hand, aren’t you?

Sandy Pardue: Not so much as by hand, but to track things. Like for instance, in any business…

Howard Farran: I meant by hand, it won’t be a part of their management information, Dentrix and Eaglesoft.

Sandy Pardue: Right, exactly. It is like the practice management system is not going to be able to tell the doctor how many calls went out and how effective they were on the phone. That would be something that is important to be measured. And all practices, even doctors that call me are really unsure about how to pull reports, because there are so many ways. There are 400 reports on some of the software and they don’t know how many new patients they are getting. They can’t tell me. “Well, I will have to talk to my office manager and get back with you. I don’t know how many new patients I had.” So it is hard for the staff and the doctors to work through these processes.

Howard Farran: Yeah, and there shouldn’t even be 400 reports. There should be an end of day report, an end of week report, and end of month report. I mean, it should only report what you need to know. I mean, the fact that you have 400 reports means that whoever is programming these reports has no flipping idea what they are thinking about.

Sandy Pardue: They are giving the user too many options.

Howard Farran: Yeah, because nobody knows what they are talking about.

Sandy Pardue: That is right.

Howard Farran: Yeah. I bet you all of those programmers that write that software, the only time they go to a dentist is when they get their teeth cleaned every six months. You know?

Sandy Pardue: Exactly, yeah.

Howard Farran: So what would you tell them to do if they have Dentrix, Eaglesoft, Softdent, Open Dental? First of all, which one of those is the least – you know – I always think of voting in America, Republican or Democrat, it is like deciding whether you want your leg amputated above or below the knee. I mean, it is always like the two most horrible options.

Sandy Pardue: Right.

Howard Farran: But of all the options available, which one is the least worst nightmare option to get? What would you recommend?

Sandy Pardue: What I am seeing the most is Open Dental.

Howard Farran: Yeah.

Sandy Pardue: That is what I am seeing the most.

Howard Farran: Open Dental. And they are out of Chicago?

Sandy Pardue: I am not sure where he is out of, but I would say 50% of our clients are Open Dental clients.

Howard Farran: Do you know the owner of Open Dental?

Sandy Pardue: No, he has never reached out to me. And I promote his software a lot, because it is so simple. And I have never seen a software take advice like Open Dental does. The enhancements are amazing, they are fast.

Howard Farran: Yeah. You know, I have had that problem with Dentaltown since day one. When we started Dentaltown, a lot of the dentists didn’t want dental manufacturers on there, because they were like, “Oh, well they are just trying to sell something.”

Sandy Pardue: Right.

Howard Farran: And I am like, “Doc, what are you, a volunteer? What do you just do free dentistry in your community in a homeless shelter?” You know, and I wanted the dental, I own Dentaltown and I went with Dentaltown because I wanted folks like you on there. I wanted the dental manufacturers on there, because if all of the dentists wanted a red widget and you were making blue widgets, you need to be in a community with these guys to realize that you need to make it different. And I think Open Dental is a genius. When dental manufacturers call me and tell me if I don’t take down a complaint about their product they are going to sue me, I go, please sue me. Please, I am going to publish it. I am going to put it on the front page of Dentaltown. This is going to be your worst nightmare. And then number two, I tell them, if you were smart you would get on Dentaltown and engage. This is your customer and he is pouring his heart out and he is upset and then you want to punch him or sue him. So I tell them, you should engage them.

Sandy Pardue: Right.

Howard Farran: I am very, very proud of the Open Dental people, because I see that all of the time. They are always asking, “What do you want? What do you need? What do you not need?” So yeah, I would have to go with Open Dental, too.

Sandy Pardue: Yes, very simple to use and they have actually taken things that required paper and made it so they don’t need to have as much paper. For the communication between the doctor and the front desk and that kind of thing. They have done a great job.

Howard Farran: Yeah. Okay, so if you were going to consult an office today, and say they didn’t have Open Dental, what type of systems are you going to be trying to incorporate and what would this be like for the doctor?

Sandy Pardue: Well the first thing we are going to look at, there are about 42 practice management systems that are very important. It could be from answering the telephones to greeting patients to handling the insurance, the accounts receivable, sterilization areas, the new patient process. So there are about 42 of them. So what we are going to do is pull some computer reports. We are going to look at the production, we are going to look at the average hourly production for the hygienist and we are going to watch and observe each system. So I am going to pay attention to the patient retention. That is always interesting. It is one of the first things that we do when we work with a practice. And we are seeing that, by the way, in about 40% to 50%, which is gross. But that is what it is running. And so we are going to really learn about the practice. We are going to dip deep and find out how the processes, which they usually do not have, new patients handled differently every other day and the recall. They don’t want to put it in writing or there is no financial policy that is standardly followed. So we are checking each one of those systems.

Howard Farran: And Sandy, if I am out there in the middle of Omaha, Nebraska. I am in Kansas City, I am in Parsons, Kansas and I need help, what do you, and formally I tell everyone, people say to me, “What practice management consultant do you recommend?” You are always my number one choice. I mean, you always are.

Sandy Pardue: I really appreciate that.

Howard Farran: But what would you recommend this guy do first? Because I know you do like, three day lectures in Baton Rouge. I mean, is that a start? Or should this dentist be calling you and having a conversation or would you want to go to his office? I mean, what gets the job done the fastest?

Sandy Pardue: It actually depends on the practice. But if somebody is 100% committed to making changes and to really organizing their practice, it is not something that can be done in two or three days. It is a process. And so what we recommend is first starting with an employee handbook, which most practices do not have. So we work with them to get that done, a legal employee handbook. We learn about their practice and then we want them to come down here to me where I give a full day leadership training and two full days of getting their team working together on a vision and getting them set up to keep statistics and track different practice monitors, which most of them have never done. And then we start looking at how they are scheduling and handling their patients with confirmations.

Howard Farran: And that is a three day seminar?

Sandy Pardue: Yes, it is.

Howard Farran: You know, I live in the fifth largest city in the United States, Phoenix, Arizona. It has got a 4.7 million person metro. If you would email me and set up a three day date for Phoenix, I mean, I will do all of the marketing for you. I would fill that room to maximum capacity for you. You should make bank on that.

Sandy Pardue: Okay.

Howard Farran: And I am doing it for selfish reasons, because I would like to send 50 people there. But anyway, yeah I would love to set that up. Because we totally enjoyed you when you came out to our office. But I would love to do that. And what is the difference between the three day lecture and having them come in your office? What do you typically do in an office? Do you go in for a two or three day period and then one day a month for like a year or two years or how does that work?

Sandy Pardue: We are following up, after the three days, we are following up with unlimited support, unlimited phone calls and Dental Dashboard, which is our own software done via Internet where the staff is entering their practice monitors. I want to know how many calls they are making out, how they are running after the collections. I want to keep up via Internet almost in real time what is happening in that practice. So we are doing that and then we are going into the practices for three visits, two day each, over the course of a year. No practice has ever gotten worse and the average is about 30% increase in production.

Howard Farran: Yeah, I mean, and the reviews are all on your threads on Dentaltown. I mean, I am surprised you haven’t changed your name to St. Sandy, because I am sure you will be canonized one day on Dentaltown. But Sandy, another thing about that incoming phone, are there any softwares, I noticed when you walk into a Domino’s Pizza or a Pizza Hut, when someone calls on the line, it pulls up the screen. The phone is coming in digitally on an IP address, usually bundled with your cable provider with Internet and HBO or whatever. Do we see that in dental software anywhere?

Sandy Pardue: I believe Sesame does something like that.

Howard Farran: But again, that is not a management information.

Sandy Pardue: It should be part of the software. It should be part of the software.

Howard Farran: But is it part of Softdent, Eaglesoft, Dentrix?

Sandy Pardue: I am not seeing that, no.

Howard Farran: You know, I have never met a dentist that could tell me how many incoming calls he had, how many of them went to voicemail.

Sandy Pardue: That is right.

Howard Farran: Were they answered on average on the second ring, third ring, fourth ring, fifth ring. There is 168 hours in a week and I say, “Are you open Saturday?” No. “How many incoming calls do you have on Saturday?” No idea. And if you had ten incoming calls, how many of them were existing patients versus new patients? I mean, when I look at what dentists have to work with, with Softdent, Eaglesoft and Dentrix, I mean, they should call it the Stevie Wonder, Ray Charles deal, because it is somewhere between blind and alive and blind and dead. I mean, that is what these dentists are working with.

Sandy Pardue: Right.

Howard Farran: I swear, sometimes I always think Sandy, you and I should just start our own software system. I mean, I don’t think they are ever going to listen.

Sandy Pardue: No, the doctor is held hostage by it, too.

Howard Farran: Yeah. Incredibly sad. Incredibly sad. But anyway, staff training. What do you recommend for staff training? You know, I have always said that the one thing I like is Dentaltown has 250 one hour courses. I always recommended lunch and learns. Is that a via opposite, a lunch and learn? And is providing lunch okay, or should you also pay the staff? Is it an hour? Talk about that.

Sandy Pardue: Well you definitely, any time you are teaching your staff something that is going to help them with their position in the office, yes, you have to pay them.

Howard Farran: Okay.

Sandy Pardue: So if you want to keep them over for lunch for training, you have to pay them, even if you buy their lunch. Now, this could vary state to state, but that is pretty much how it is. And you want to take every opportunity for training. This is the deal, dental offices hire staff, many of them never went to college, a lot of them have GEDs, they never finished high school, and they are put in a position to run a million dollar or two million dollar business. And they are ultimately responsible for the car that the doctor drives, the house he lives in. And they have no training. They bring their knowledge from the practice they worked in down the street. And doctor thinks, “Well, he was doing two million. If I hire her to be my scheduler, I am sure I am going to do two million.” And that is just not the way it is.

Howard Farran: And why is that not the way it is? I mean, it sounds like a very plausible, good theory.

Sandy Pardue: Because it takes more than one person to have a two million dollar practice.

Howard Farran: We saw that with Meg from eBay. And she was just all that and then they hired her over at HP and they didn’t get any of the results and everybody in Wall Street was saying that was because Meg had a huge team at eBay.

Sandy Pardue: That is right.

Howard Farran: And the press gave her all of the credit, but when HP hired just that one person, nothing. They didn’t get the eBay effect.

Sandy Pardue: And this is dental offices.

Howard Farran: You are right, it is a team office. So Sandy, you know we were talking earlier. You said a dentist leader takes hundreds of hours of CE. I took 500 a year for 25 years. What would be a reasonable, good diet of staff training, CE, online lectures? How many hours, days a week, a month, a year? What would please you?

Sandy Pardue: We always advise our clients, our new clients coming in, that when they first start our program they have at least two one hour staff meetings in a month. Once they get moving along, then they can cut it back to one staff meeting per month. But it also depends on some one-on-one training by the consultant doing webinars and things like that as well with the individual person depending on their position. So it never ends. Training really never stops.

Howard Farran: And the key training that I see in the office, and I want to go through all three of those, one is the scheduler, another one is the financial arrangement and the third one I want you to talk about also, because on OrthoTown, the surveys on OrthoTown say that about 95% of the orthodontists have a treatment plan presenter that is not the doctor. And then in dentistry it is about 5%.

Sandy Pardue: Right.

Howard Farran: So can you talk, and I missing anything? Schedule, financial arrangement, treatment plan coordinator? Is that it?

Sandy Pardue: The insurance coordinator.

Howard Farran: The insurance coordinator. Start with, can you talk about all four of those and how you would train someone to do that? And start with the treatment plan. I want to pose you the question, why do 95% of orthodontists have a non-orthodontist present the treatment, and that is not even 5% in dentistry?

Sandy Pardue: Okay, well here is the thing with dentists. They, if you will notice when you talk to them and ask about their practice, they are always going to have a lot of people working around them in the technical area. They are going to make sure they have the people they need. But when you look at the administrative area…

Howard Farran: Are you talking about endodontists, periodontists, prosthodontists?

Sandy Pardue: I am talking about general dentists for the most part. And so you take the orthodontist, which you mentioned, has a treatment plan coordinator. Well, it is because he has figured this out. So he has got his technicians working on the patients, but he needs someone to present. Well, he has got it figured out in that industry. Now, when you go over to the general dentist, you see them with just the bare minimum administrative staff, administrative people. Enough to just process the people, answer the phone, check them out. But they will have a lot of technical team members. So that is the first thing that dentists need to look at, do I have enough staff at the front to handle the load.

Howard Farran: Are there any ratios that you like?

Sandy Pardue: Yes, there are.

Howard Farran: What are your ratios?

Sandy Pardue: If there are zero to 19 patients going through the practice a day, in other words, you can’t take the production level to decide how many administrative staff you need, because if you did that, I mean, I have clients doing six million a year that have four admin people. But their procedures, like implants and that kind of thing, they are more expensive. They don’t need as many people to greet the patient, to confirm the patient, to process them. So if you have zero to 19 people you need one person. I have actually taken a stopwatch to this. So then you have over 19 up to like 32 people, you are going to have to add an administrative person. So then when you get past 32 you need to add a third one, up to about 45-ish and then you would add the fourth one. That means you need that many people to process the insurance and the billing and all of this. But what happens with general dentists is they are so worried about the back where they are and having enough team members that the part of the practice that keeps the back busy is left unmanned. So that is one reason why you don’t see as many treatment plan coordinators.

Howard Farran: Okay, and you would think that, because since the dentist is the owner, and the dentist, she is focused about what she is doing and she needs her assistants and she doesn’t want to do hygiene and blah, blah, blah. So is the dentist’s spouse up front, because now you have two owners in the practice. Does having a spouse up front, is that in your experience a good thing or a bad thing?

Sandy Pardue: I love it.

Howard Farran: Yeah.

Sandy Pardue: When a doctor calls me and says, “My wife is working in the practice,” I get so excited, because I know that practice is just going to move forward so fast.

Howard Farran: And I want to talk about that, because in our industry, it is just the horrible reputation. Oh, the wife is in the office. Staff come and interview, “Oh, well you know, his wife worked in there and she was a nut job.” And what I have picked up on that is, and I am an MBA and any economist would tell you that if your employees own part of the business, they are going to be far more focused and all of that. And what I think it is, is I think the industry hates the doctor, most of the time it is the wife, the doctor wife up front, because she is the check and balance. She owns half the practice and she is not putting up with all of your bullshit. You can’t sit there and let the phone ring seven times while you are posting on Facebook. And of course they don’t want the doctor’s wife in there, because she is going to sit there and hold their feet to the fire.

Sandy Pardue: That is right.

Howard Farran: So these young dentists that hear all of these bad reputations, it is by a bunch of lazy union workers. And I also see like a dentist making 100 and then their spouse is out there making 50, and I am like, well if your spouse would work in the office, you guys would be making 300 and now it is 150 each. You know, you both make more money. So I am a huge fan of the doctor’s spouse in the office.

Sandy Pardue: Oh, I am too. And so many of these doctors, and this kind of goes into this embezzlement aspect, is these doctors get themselves into situations with their staff that they really shouldn’t when the wife is not around, if you know what I mean. And these girls own these doctors. I see it all of the time.

Howard Farran: Because of improper relationships?

Sandy Pardue: Yeah.

Howard Farran: Yeah, so what percent of embezzling is from a woman that you are having relations with on the side?

Sandy Pardue: I have seen it, but I have seen more blackmailing. Maybe another staff member knowing that it is happening and holding that over on the doctor and stealing and saying, “Look, you can’t say anything, because you are doing this.”

Howard Farran: Yeah. So yeah, but on the other hand on your own seminar and I am quoting you, I am holding your feet to the fire, if your wife is planning on a divorce and she is thinking a year out, she might have started embezzling you, right?

Sandy Pardue: Absolutely, I have seen that, yes. And the mother-in-law.

Howard Farran: And what, a mother-in-law? What was she doing?

Sandy Pardue: The mother-in-law and the wife were both embezzling together, insurance checks, about seventy-something thousand dollars.

Howard Farran: Yeah, and another thing I was amazed at, whenever I talk to dentist I always say, you know, was there a character trait? Like you would think, well maybe she goes to church every Sunday and she has never been divorced and she is faithful to her husband. She would never embezzle. And that doesn’t seem to add up. I mean, it is not like some shady character who goes to happy hour every day at 5 o’clock and cheating on her husband and some crazy wild person. It seems like some of the most outstanding, upstanding, at it seems like also when you say a lot of the times it is the person the dentist trusts the most.

Sandy Pardue: Absolutely. Loyal, long-term, absolutely.

Howard Farran: Yeah, loyal, long-term, absolutely. So we talked about that. So I would just say if you want more on that, your course is outstanding on embezzlement. But what are some red flags and how could a doctor check for embezzlement?

Sandy Pardue: Right off they need to be a leader and start requiring the staff member to send them end of the day reports. They need to see day sheets, adjustment reports. And a lot of staff will say, “Doc, you don’t need to see that.” Well yes, you do need to see that and you need to demand. And if you don’t get it, you keep asking for it. I need that, I need that, until you get it. And if she skips a day, you go right and ask for it. Even if you don’t look at the end of the day reports, make her think you are looking at it. Even if you don’t understand the software, which I hope that doctors learn their software, at least act like you do. They need some ethics presence there.

Howard Farran: Okay, there is also some separation of powers, I mean, you don’t want the person getting the mail and depositing the checks. Talk about separation of powers. Because a lot of times, the office manager does everything. So she is perfectly poised to embezzle.

Sandy Pardue: I think the doctors that are listening to this, I think they can, a lot of them can actually recall times in their own offices where the person that enters the checks is actually real anxious to get the mail. I think it is just part of that position of that accounts receivable person. And in most practices, the mail goes right to that person and that is the first thing you should stop.

Howard Farran: Okay, go into more detail. So you are saying, okay, so the person getting the mail and getting the insurance checks should not be doing what?

Sandy Pardue: Be the same person that enters the payments into the computer. It should be a different person. So you should have one person open the mail, stamp each check for deposit only that comes in the mail and then hand them over to the person that is going to enter the payments.

Howard Farran: And when they stamp it for deposit only, that means they can’t deposit it in their own personal account?

Sandy Pardue: Right, that is right. And doctors say, “But Sandy, that is impossible. How could they take an insurance check made out to me and put it in their own bank?” Uh, yeah. Almost every embezzlement case has that happening.

Howard Farran: And I have to admit, it happened to me. I opened up in ’87 and I was barely out of the gate. I think it was ’88. And a check was just missing. And it wouldn’t come in and wouldn’t come and I finally called Chase and I said, “I have lost a check.” And they go, “No, it cleared for $3,000.” And I said, “Who was it for?” And it was an assistant that took the check, made it out for herself, and the bank was able to give me a picture, an eight by ten picture of her at the deal signing it. So I walked down to my bank, they gave me a canceled check, $3,000, a picture. And I called her into my office and I just sat that down and I said, “Can you explain this?” And she just burst out bawling and ran out of the room and I have never seen her since.

Sandy Pardue: Oh, wow.

Howard Farran: So she got $3,000, but just crazy stuff happens. And that was because I didn’t have my checks locked up just in my top drawer.

Sandy Pardue: Oh, wow. Well I will tell you one thing we are seeing right now a lot of is the staff are crediting their own credit cards onto your terminal. So during the day, somebody comes in, they pay $3,000. They will pull out their own credit card and have a credit on their account. So the listeners need to look at their statements and check their end of the day reports. But make sure, you shouldn’t have credits in dentistry. You should not have any credits for dentistry.

Howard Farran: Wow. That is interesting, crediting. So what percent of the offices, you have been in-office consulting for 25 years. What percent of the offices is someone embezzling?

Sandy Pardue: Well, the ADA says 38%, but come on. That is just the ones that we know about.

Howard Farran: Yeah.

Sandy Pardue: That is just the ones that we know about. So I am thinking it is more like 50%.

Howard Farran: Yeah, we have always thought half.

Sandy Pardue: Yeah.

Howard Farran: And another caveat also is 18% of dentists will go check themselves in for rehab during their career. And to put that in perspective, 18% of Americans will be considered an alcoholic or an addict. So it is the same, dentists and the general population. To put that in another perspective, in Ireland it is 38% and the number one country is Russia at 40%. They just have a huge problem with vodka. So dentists, 18%, the same as the general population. The people that have it the worst is anesthesiologists. They are about 38%. But I have seen a lot of embezzlement where the doctors get addicted to alcohol, which is low cost and cheap and you can buy anywhere. And they get addicted to prescription pain meds and then their getting them with their assistant or whatever. And then that person is embezzling.

Sandy Pardue: That person is holding that over his head.

Howard Farran: Yeah, it is like, “Doc, you can’t say anything, because I have filled 50 prescriptions for Vicodin for you over the last couple of years and you are addicted to OxyContin or Vicodin or Percocet or whatever.” So yeah, that is kind of a sad part of dentistry. It is sad that we don’t talk about stuff like that, but that is real. So talk about the telephone. Sandy, I believe that there are 168 hours in a week and I am thinking about the average dentist is open Monday through Thursday, eight to five, 32 hours a week. So 32 hours is only 19% of 168. So when I see data on an office that gets a new IP address phone system and software, half of their incoming calls are coming in when they are not even open.

Sandy Pardue: Right.

Howard Farran: And the half that come in when they are open are going to voicemail. And most calls that go to voicemail don’t leave a message. And then I will ask the doctor, I will say, “Doctor, are you patient-centered, patient-focused? Or is it all about you, are you doctor-centered?” And he will go, “Oh, we are very patient-centered.” And I am like, “Dude, your office hours are Monday through Thursday, eight to five, and you take lunch 12 to one. And when these people are stuck in traffic for an hour or two, they are calling you from their car and you are not open. And then to take lunch from 12 to one when the only time the working man can step out on their break and call you, and you are closed there?” So I want you to talk about office hours. Does that tie into success? Do you recommend taking lunch 12 to one? And what about that phone, if you open up at eight, what about those calls that are coming in between six and eight? And if you closed at five, what about those calls that trickle in until six or 6:30? Talk about those subjects.

Sandy Pardue: Okay, well I definitely believe the phone needs to be manned. And our most successful practices rotate lunch. The staff rotate lunch so someone is there. And they have someone work on Fridays. Now some of the practices, you well know, I am sure you have heard, like getting the cell phone for the staff member. They can bring it home on the weekend. And I think that is great. And I know that you have successfully done that in your practice. I just recently heard about one doctor that did that and the dental assistant was going to the office and actually prepping crowns and collecting the money, yeah, and the lab called with a question and guess what, the doctor was out. So doctor just has to be aware of that and have somebody trustworthy that you have got that arrangement with. But I definitely believe the phone needs to be manned up.

Howard Farran: Okay, so what percent of the dentists do you think have hours Monday through Thursday, eight to five and when you look at these one, two, three million dollar practices, are those their hours, eight to five? Talk about that, though.

Sandy Pardue: Well, it is varied. It varies so much, Howard. It is like some people, I mean, usually the docs that we work with that are doing two million and 2.5 million, they are working at least four days a week. And they have enough administrative staff to cover the phones. But I promise you, on Fridays, that phone is not left there ringing.

Howard Farran: Right. But do you recommend someone coming in before eight? You know, you talk about staff rotating through lunch.

Sandy Pardue: Right.

Howard Farran: Do you have any rotate an hour early, like to man the phones an hour before you open and rotate an hour later?

Sandy Pardue: They are coming 30 minutes earlier. They will come in like at 7:30. And also for huddles, not every person needs to go to huddles. Somebody needs to be there manning the front desk and answering the phone. But that is an option. You can do that, because you are right. I mean, the phone, is listeners will think at eight o’clock if you are standing by your office phone, it is starting to ring. People are ready to go. And the practice that picks up the phone, especially for new patients or potential new patients that picks up the phone first, they are going to get that new patient.

Howard Farran: Yeah, it blows my mind. I mean, I cannot tell you how many times I have seen this vision. I mean, like 25 times I have seen this where you go to a dentist’s office and the staff is up there and they are all talking and playing and everything and the phone is just all ringing and going to voicemail, ringing and going to voicemail. And they don’t turn the phones over until like eight o’clock point one second and I am just standing there like… I mean, what if it was their own family members calling, I broke my tooth, I’m hurt, I am in pain and they have problems. And they are just sitting there waiting for eight o’clock point one. And I am just sitting there like, how do you get… It is just, what an attitude. I want to ask you another thing that I am hearing a lot of complaints on. There are a lot of women dentists who tell me, they go, “Howard, look. I am in a group practice, three guys.” Three guys tell any of the staff, do this, get me a cup of coffee, do anything and they all jump. And then they ask them the exact same question the exact same way and they are treated differently. Do you think it is different being a woman dentist with women staff versus a male dentist and women staff? Are you seeing a problem, or is that in their own head?

Sandy Pardue: I have seen that. And again, but not 100% of the time. There are some female dentists out there that they know, this is what I want. I want to run my business. And they go in and they don’t become friends with the staff. They are the leader, but they are friendly and they are just good leaders. So again, it is the leadership that is missing. These people get out of dental school and then there is the staff and they never thought that they were going to have to manage a bunch of women. So we are running into that. So it is moreso, to answer your question, if it is a male dentist owner with a female associate, yes. I will agree with you.

Howard Farran: If it is a what?

Sandy Pardue: A female associate with a male dentist practice owner, most certainly the male dentist practice owner, or it is even if they are partners, is always going to be considered the leader.

Howard Farran: You know, I heard a great seminar by Pat Riley and he was the Miami Heat’s basketball coach and I think he played and coached some other teams. And he said a big deal about leadership is you have got to know who you are leading. And he was talking to our dental side and he goes, “You guys are all leading women. You need to study women.” He goes, “Look at me. I have been a coach. All of my employees are African-Americans a foot taller than me who make ten times more money than me who grew up in the inner city almost never with a father figure who will do anything their mom says and if a guy says the same thing, they will just punch you. So the strong leaders in their psyches are moms and aunts and grandmas, not men.”

Sandy Pardue: Right.

Howard Farran: And he goes, “So you could whine all day long that all of your employees are women. Well, I could whine all day long that mine are inner city African-Americans who grew up in houses in poverty and substance abuse and single father. You don’t whine about it. You get to know the person you are leading.” So what advice would you tell dentists, whether they be a man or a woman? How should they be thinking about getting in their head? Taking the Pat Riley describing an NBA player, describe the employees in dentistry and how do you get to understand them?

Sandy Pardue: Well, I think the first thing that is missing in dentistry is that the leader, these dentists, that they don’t really know what their ultimate goal is. And I think if they really think about what they are working towards every day, which is for the good of their practice, to deliver good quality dentistry, to have healthy patients and happy employees and have people leaving the practice and going and telling everybody about the practice, they don’t know their goals. They don’t know what the ultimate end result should be. I think when they have that and then they look for anything that is interfering with it, you see, this is their goal and then they have staff that are putting up barriers to that goal, and they don’t know how to confront that. They don’t know how to say, “Well, Susie is refusing to send recall cards.” And that is pretty important. It is actually a vital action. So instead, they are not confronting Susie and they are losing sight of this goal. They are not taking care of the patients, because Susie doesn’t want to send recall cards. They have got to look at their end result goal and then what barriers are being put up and get rid of those people. Train them first, always try to train them, correct it, put a system in, and then replace them. So that is what they are not doing.

Howard Farran: So I am going to hold you to that, because you just mentioned recall. What recall do you recommend? Do you recommend a card two weeks in advance and a call the day before? What is your standard?

Sandy Pardue: We have looked at a lot of different things and everything I do we keep statistics on. It is like, this practice sent this many cards. This is their retention rate. This is how many people responded, this is what their hygiene is looking like. So I feel like I can’t recommend it unless I know it is the best. I feel confident doing it, because my reputation is based on it. So in the perfect world, we could just email everybody the reminder. I think everybody should have email. I think that you should be communicating with your patients with email. But if you are going to save time for patients six months away for your prescheduled hygiene appointments that you need to send a physical card three weeks in advance and then follow up with your email and let the patient confirm via text or email. If you don’t hear back from them, they get a phone call.

Howard Farran: If I don’t hear back by how close to the appointment?

Sandy Pardue: You could send the email five days in advance and then if you haven’t heard back the day before the appointment, you need to call them first thing in the morning the day before the appointment.

Howard Farran: And do you recommend any of these companies that do email reminders? I mean, we have heard of Lighthouse, Sesame, DemandForce, isn’t that one of them?

Sandy Pardue: Yes, I really like Lighthouse.

Howard Farran: You like Lighthouse?

Sandy Pardue: I like Lighthouse because one thing that practices need to be able to do, and every practice has a different solution, but new patients tend to come early. Not everybody downloads the forms and fills them out, so the new patients need to be told to come a unit early or ten or fifteen minutes early. And so what happens is the practices make the appointment and they verbally say, “Sandy, your appointment is going to be Monday at nine.” Okay, well here comes my confirmation and it says the appointment is at 9:15, right? Because I need her there at nine to fill out her new patient material, but the system says 9:15, which is the real appointment time. Lighthouse allows you to go in and change that and say for all new patients they need to be confirmed via text or email fifteen minutes before the actual time. That is why I like them.

Howard Farran: So you keep talking about all of these systems that no one is going to learn on an hour podcast. How would a dentist be teaching all of these systems? Again, do you recommend your three day seminar as a start?

Sandy Pardue: I also have a Spice Up Your Practice seminar, which I do with our co-founder of Classic Practice, Dr. Robert Westerman. So we do that in New Orleans about three times a year. It is a two day seminar.

Howard Farran: Email me the dates on that. I want to come to that.

Sandy Pardue: Okay.

Howard Farran: Do you think you would ever do it in Phoenix?

Sandy Pardue: We could.

Howard Farran: Or would your three day cover that?

Sandy Pardue: The two day is a very good seminar. Dr. Westerman and I do that together.

Howard Farran: Because I am thinking two things. You know, I have got 50 employees, but half of them are Dentaltown and half of them are in the office. And I am thinking, do I send 25 to Louisiana? But I am thinking about you. I mean, this is a huge town. Do you realize how big Phoenix is? I don’t think most people, most people if you say name a big town they say L.A. or Dallas or Phoenix or whatever. But the Phoenix metro is 4.7 million. Do you realize that?

Sandy Pardue: Okay, I will come. We are coming.

Howard Farran: It is huge. It is bigger than New Orleans.

Sandy Pardue: Right, you are right. We get people that come from around the world every seminar. But they can come to Phoenix.

Howard Farran: Yeah. So Sandy, let me pose this to you. So there are 150,000 dentists in the United States and they all want 25 new patients a month. And I am sitting there taking 150,000 times 25 people and this is greater than the immigration of the United States. And then you look at the people who were born, raised, reared and died in the same zip code and they have seen a dozen dentists in their lifetime. So to me, the numbers say that Americans are just going in and out of dental offices their whole damn life. Why does every dentist, in fact, tell me this. A dentist has been practicing for 25 years. Why does he still need new patients? And then I go up here to Colorado River and they have built a little bitty dam and it has backed up water, you know, literally 100 miles. So what is wrong with patient retention in dentistry? Why do Americans see a different dentist every five years and why does every dentist still need new patients after 25 years?

Sandy Pardue: Okay. Oh, I get excited on this one, because it is such a blind spot and it is in most practices. So dentists call me. “Sandy, I have got to have new patients. My chair is empty. I don’t know what to do.” Okay, well I will tell you what. I would like you to pull up a report for me. I would like to find out how many people have not been in in three years. I can hold while you do that or you can call me right back if you don’t know how to pull up the report. It is amazing how many people, hundreds if not thousands come up on the report. They are shocked. “What happened?” Well, I will tell you what happened. It is kind of like they, a lot of these automated software systems, you have got to make sure that this isn’t happening. Listeners need to really listen to this. If you are using DemandForce, Lighthouse 360, Smile Reminders, any of those, you want to make sure that after one year they are still communicating with your patients. If you are not, a lot of them, they will default at the one year, 12 months. Now I think everyone here could say there has been a time that they maybe went to have a manicure somewhere, their haircut, and for some reason they went somewhere else for that one time and then they start thinking, “Oh, my hairdresser is going to find out I cheated on her.” Right? And they get embarrassed. And I think that happens in dentistry. People try another office and they don’t like it and we stop communicating with them, so they are embarrassed to come back. And practices need to constantly communicate. I mean, you look at, what is it? 47% of the people going to the dentist every year? It is a real problem in dentistry. People don’t know what we know about dentistry and no one is educating them. So we have got to constantly educate and stay in touch with them and send them various things, birthday cards, holiday cards, reactivation projects. All of these things need to happen, and let me tell you, it is a goldmine. They are all sitting on the goldmine. They need to not give up on people. That is a huge out point in most every practice.

Howard Farran: And another thing I like about that is 91% of appointments are made by women and when your phone is ringing with organic, old patients, patients that haven’t been in for three years, they are coming in with trust and women are never going to give you money until they first trust you and it takes a long time to build their trust. You can ruin it in a minute and then never get it back your whole life, whereas when you go do a coupon, some woman is coming in here, she doesn’t know you, she is a little leery, she is walking around and they are much harder to sell. And I would rather work with all of the people that you have helped over the years and worked on and have a relationship, because a trusting woman will listen to you and bring her kids in and her husband in and her mother, whereas the lady on the Groupon deal is a whole other leery animal. It is kind of like if I had every woman I ever asked in American, if I said, you know, if your air conditioner didn’t turn on and you called the air conditioner repair man and he came out in a three piece suit and said, “I’m sorry, but you need a whole new air conditioner.” What is the first thing you think? And every woman says, “Oh, he just wants to sell me a new air conditioner.” If it was my cousin or my grandpa or my brother, he probably would have given it a shot of Freon and fixed it with duct tape and WD-40. So women don’t trust men. So I am a big fan of trying to keep the people that have come in and they have met you and they know you and they have had their teeth cleaned and you have had a relationship with them for years. Why are you going after a stranger in the yellow pages?

Sandy Pardue: Right. Well, I will tell you there is a lot more upset patients than practices realize. In other words, something happened in the practice that really made them mad and no one pursued them. Most of the time dental offices run from upset patients, instead of to them. So it could be maybe they hadn’t had their teeth cleaned in four years and they go see the hygienist and now they go home and their gums are sore and how guess what? They blame the hygienist and the practice and they never come back. Or maybe they are told that they need SRPs and they don’t understand that. So part of the reactivation is to go through and call these patients that aren’t returning and ask them one simple question, how was your last visit to our practice. And you would be amazed at what you learn.

Howard Farran: And I want to say something also to the young kids out there that are 25 years old versus how we see people at 50 years old. I mean, when you are 25, everything is black and white and you get mad at this person and all of this. By the time you are half a century old, you have got to realize a human is made up of 3.6 billion base pairs making a quarter million genes. Their brain has a trillion circuits. They are so complex. It is not what you said, it is how you said it. It is now what they hear, it is how they filtered it. And it just drives me crazy when a dentist will see a bad review on Yelp or on Google and they want to call and attorney and go sue the patient. It is like, are you kidding me? A patient is upset, crying out for help. So I tell my four boys every day, people are complex. If you say hi to a guy and he bites your hand off, maybe his dad just died, maybe his dog just got ran over, maybe he is fighting a cold, an infection, a mental illness. I mean, give everyone fifteen breaks and keep communicating with them and being positive. How was your last appointment? If they get mad, we see it all of the time. We ask everybody that comes in our office, why did you leave your last dentist? “I just wanted to get my teeth cleaned and she wanted to do all of this deep cleaning stuff. I mean, she just wanted money.” And it is like, well I know the hygienist didn’t want just money. But they didn’t communicate. They didn’t see eye to eye. So Sandy, I have only got you for four minutes left. So I want to hit you, close with the big question. And that is, dentists all of the time on Dentaltown, they don’t know. They have got a dental assistant, a hygienist. How do you know when to keep reinvesting in continuing education and time and more training with an employee versus, you know what, I need to pull the plug. Kind of like this, you are down there, I know you are a big New Orleans Saints football fan. How do you know when, no we are getting rid of that quarterback or, no we are going to keep that quarterback? Is he too old? I mean, Drew Brees was great the years ago. So give me some guidance about when it is time to, you need a new quarterback versus, no you need to give some more training and send them to your two day Spice Up the Practice seminar?

Sandy Pardue: Well, this is the thing. Dentists don’t want to confront these management type issues, but they need to. So you need to have a system in place for whenever someone, first of all, they need protocols as to what to do and how to do it. Everybody needs a checklist. Every staff member needs a checklist. From the checklist, that is how it becomes easy to manage them. So when they start skipping things and you have having to send your assistant back several times to go get instruments she forgot, they didn’t set up for an extraction, she forgot half of what you needed, you know, that is an indication right there that they get a policy review, right then. Go over with them, I needed you to do this and you didn’t do it. And then you know. You don’t put up with people that keep giving you headaches and stress. Life is too short. They are holding back the whole team. And that is what they need, if somebody needs to be written up several times, that is it. You can’t keep this person. They are holding the whole team back.

Howard Farran: How often should the regular staff get a performance evaluation? Is that something that you recommend yearly, quarterly?

Sandy Pardue: Well, this is the thing. Most people think that performance review is a raise. So I believe that when you have systems in place, you don’t need the performance review. You don’t have to wait a whole year to find out, “Oh my gosh, I am not doing well? Oh, I am so shocked.”

Howard Farran: You should have got a Tony or a Grammy or an Oscar for that. You just nailed it.

Sandy Pardue: So it is every day. It is a process. Getting organized in the practice, it is a process. Training people, it never ends. And so when you are not getting what you want to achieve that goal that you want, these people are putting up barriers, that is it.

Howard Farran: And I always see one thing in common that maybe I shouldn’t say, but I always say it. It seems like the doctor who has multiple wives, multiple staff turnover and four out of five patients haven’t come back. Or he has had one wife for 50 years, he has had most of his staff for ten, 20, 30 years and most of his patients are on recall. It seems to me like this person’s entire life he figured out relationships. It doesn’t matter if it is with your mom, your wife, your staff, your patients, or they have never figured out people and relationships. And then they will go to 14,000 occlusion courses trying to have every burr in the world on how to adjust a crown and the person’s personal life is just a disaster. His family, patients, spouses, no one will stay in the same room with this person and he wants to go to the Pankey Institute for five more months. But hey, we are out of time. And Sandy, I just want to tell you, anybody out there listening, Sandy is the gold standard. Like when we talk about obturating a root canal, we compare everything to gutta percha. When you talk about dental consultants, everything is compared to Sandy Pardue. You are keeping it real. You are so transparent. I mean, everything you believe has been posted on Dentaltown for 20 years, so if you agree or disagree, there is entire threads fighting over the details and you always land on your feet and you always win everyone over. And the bottom line is, everybody I know that knows you, they just love you. Everybody just says that you are just a good person. Thank you for all you do for dentistry. Thank you for all you do for Dentaltown. If you ever want to honor me and do another one of these, let me know. Sandy, you are the greatest.

Sandy Pardue: Thank you, Howard.

Howard Farran: And I hope you come out and do a two day Spice It Up in Phoenix.

Sandy Pardue: I will do it.
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